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TMS, Ketamine & Therapy, Coordinated Into One Plan
Proven Protocols, Tracked Outcomes
Houston Mind & Brain offers supervised intranasal ketamine as part of a comprehensive approach for adults with depression and other mood conditions that have not responded to standard treatments. Ketamine-based therapies are used when people need faster symptom relief than typical oral antidepressants provide. They may be offered alone or together with psychotherapy (Ketamine-Assisted Psychotherapy). With careful screening and in-clinic monitoring, we provide evidence-based, physician-led care to maximize clinical benefit.
What Is Intranasal Ketamine?
Ketamine is a medication that has been used safely in medicine for decades. In psychiatry, it is used for its rapid-acting effects on depression and related conditions. When administered intranasally, ketamine is absorbed through the nasal lining and can be given in a monitored, in-clinic setting.
There are two forms of intranasal ketamine used in clinical care. Spravato® (esketamine) is an FDA-approved medication, while intranasal racemic ketamine is commonly used off-label as part of evidence-informed treatment. At Houston Mind & Brain, we offer both options and help determine the most appropriate approach based on your needs.
Intranasal Esketamine vs Intranasal Racemic Ketamine
At Houston Mind & Brain, we offer two intranasal treatment options: esketamine (Spravato®) and racemic ketamine. While they are closely related, they differ at the molecular level. Racemic ketamine contains two mirror-image forms of the molecule (R- and S-ketamine), whereas esketamine is composed of only the S-enantiomer. These differences may influence how each treatment works, and how it is experienced.
During your evaluation, we’ll help you compare these options—including clinical effects, cost, and logistics—so you can choose the approach that best aligns with your goals.
Intranasal Spravato (esketamine):
- Its chemical composition purely contains (S)-ketamine (AKA esketamine). This product is sold under the brand name: Spravato.
- It is an FDA-approved treatment with a specific label, monitoring, and REMS requirements.
Intranasal Racemic Ketamine:
- This contains a mixture of 2 molecules whose molecular structures are mirror-images of one another: (S)-ketamine (esketamine) and (R)-ketamine. The mixture is also referred to as racemic ketamine.
- It is not FDA-approved, but is used as an off-label treatment with growing scientific evidence demonstrating positive outcomes.
Who May Be a Good Candidate?
Have treatment-resistant depression (inadequate response to multiple antidepressant trials)
Need rapid symptom relief (including in cases with immediate suicidality presentation or risk)
May benefit from Ketamine-Assisted Psychotherapy (KAP) to pair psychotherapeutic work with ketamine’s potential to induce neuroplasticity in the brain.
How Does Ketamine Work?
Ketamine acts primarily as an NMDA receptor antagonist within the brain’s glutamate system. This action rapidly alters glutamate signaling and appears to promote neuroplasticity - a capacity of the brain to form new, healthier connections. Clinically, this mechanism can translate to faster improvements in mood, suicidal thinking, and motivation compared with typical antidepressants, which usually take weeks to work. The intranasal route provides a practical clinic-based delivery that can be supervised for safety.
Safety & Side Effects
Ketamine is generally well-tolerated under supervision, but we monitor for and manage common short-term effects such as:
Dissociation or feeling “spaced out”
Dizziness or lightheadedness
Nausea
Sleepiness/fatigue
Temporary increases in blood pressure
Serious adverse events are uncommon when treatment is performed in-clinic under medical observation. We perform pre-visit medical checks (including blood pressure and relevant histories) and will re-evaluate and adjust treatment when risks outweigh benefits. Long-term use requires medical oversight for potential cognitive or urinary effects; we discuss these risks when appropriate.
What to Expect
Psychiatric history, meds review, medical precautions, and informed consent. We explain likely benefits, side effects, and after-visit planning (you’ll need a responsible adult to transport you).
Evaluation & safety screening
After several visits over 1–2 weeks to establish tolerability and early response, personalized treatment schedules are created.
Initial test or induction sessions
In-clinic dosing & observation
Intranasal ketamine is administered under clinical supervision; vitals and mental state are monitored during dosing. We also typically observe patients for a period after dosing to ensure their safety.
After the primary treatment stage as determined by patients’ personalized plan, we taper to fewer visits and plan maintenance dosing or combine with psychotherapy and medication management as needed. Some patients proceed to KAP sessions to integrate psychological work while the brain is ready to form new connections.
Follow-Up & Maintenance
Ketamine-Assisted Psychotherapy (KAP)
KAP combines ketamine dosing with structured psychotherapy to deepen therapeutic gains. At HMB, KAP is offered when clinically appropriate and is scheduled to align medication effects with psychotherapeutic processing.
Cost & Insurance
Intranasal racemic ketamine is offered as a self-pay treatment and is not covered by insurance. Each session is $300 and includes the medication, observation, and monitoring. The initial consultation is billed separately and may be eligible for insurance coverage. Ketamine-assisted psychotherapy (KAP) is not included in the session price and is billed separately. When therapy is combined with ketamine treatment, we offer discounted bundled pricing. Total cost will vary based on your treatment plan.
Example self-pay scenarios
If your consultation and follow-up are billed to insurance (e.g., $30 copay each), a typical 6-session course would be approximately $1,860 total ($30 consult + $30 follow-up + $300 × 6 sessions)
If your full treatment is self-pay, a typical 6-session course would be approximately $2,600 total ($500 consult + $300 follow-up + $300 × 6 sessions).
Insurance & billing
Intranasal racemic ketamine is not billed to insurance and is offered as a self-pay treatment. We provide clear, upfront pricing so you know what to expect before starting care. If applicable, consultations and follow-up visits may be billed to insurance based on your plan. Financing options for eligible self-pay services may be available.
Example pricing scenario: If your consultation and follow-up are billed to insurance (e.g., $30 copay each) and you complete a 6-session course with ketamine-assisted psychotherapy (KAP) at the discounted rate ($100 per session), your total cost would be approximately $2,460:
- Consult: $30
- Follow-up: $30
- 6 × ketamine sessions ($300 each): $1,800
- 6 × KAP sessions ($100 each): $600
Frequently Asked Questions
How soon will I feel better?
Many patients report improvements within hours to days after ketamine dosing; commonly, benefits continue to build across the first several sessions. Individual results vary.
Can I drive after a dosing session?
No. You must arrange for a responsible adult to transport you home and remain with you as advised; we observe patients until it’s safe for discharge.
Is intranasal ketamine FDA-approved?
No. Racemic ketamine used intranasally is generally an off-label application for depression. Spravato (esketamine) is FDA-approved under certain conditions; racemic ketamine is used off-label based on research and clinical experience. We’ll explain the differences during your consultation.
What if I want psychotherapy with ketamine?
Many patients benefit from pairing ketamine with psychotherapy (KAP). HMB coordinates medication dosing and psychotherapeutic timing so you get integrated care that maximizes both safety and psychological benefit.
I have greatly benefited from the services of Houston Mind & Brain. I would encourage anyone seeking neurological or psychiatric treatment to visit them. I have particularly benefited most from their TMS treatment. It has changed my life for the better in so many ways. They have knowledgeable and friendly staff and providers who really do care about your health and because they are a smaller office you really do get that personal connection with the providers and staff. Highly recommend!
Jessie
Comprehensive Psychiatric Care
Related Services
We Accept Insurance and Make Care Affordable
We accept most major plans for FDA-cleared treatments (including standard TMS and Spravato). We verify benefits, manage prior authorization, and provide a written estimate before treatment so there are no surprises.
Do you accept Medicaid?
No - we accept Medicare but do not accept Medicaid. If you have questions about coverage, call our team and we’ll help.
Will my insurance cover TMS?
Many commercial plans cover standard TMS when medical-necessity criteria are met. Accelerated/fast-track TMS is often self-pay. We verify benefits and submit prior authorization on your behalf.
What if I’m out of network?
This is uncommon because we are credentialed with most plans. If needed, we can provide a superbill for out-of-network reimbursement.
How do I get a written estimate?
Request a free 20-minute expert call. We’ll run a benefits check, explain likely coverage, and send a written estimate of patient responsibility before any treatment.
Can I get sliding scale pricing for TMS?
Yes. We offer sliding scale pricing for eligible patients and can provide a written cost estimate before treatment. To be considered, we’ll ask for proof of income, such as tax documents.
At this time, sliding scale pricing is not available for Medicare patients or for accelerated TMS protocols.
Integrated Care That Delivers Results
Research-informed care that integrates medication management, psychotherapy, TMS, and Spravato/ketamine into a coordinated treatment plan. Treatments are thoughtfully sequenced and monitored within a structured clinical model to support safety, consistency, and meaningful outcomes.
Why Choose Houston Mind & Brain?
MD-led, research-informed brain health - advanced treatments, personalized plans, and practical insurance support.
Insurance Help & Clear Pricing
30+ Years MD Led Psychiatry
Accelerated TMS & Fast Track Paths
Clinical Research & Outcomes Tracking
Integrated Treatment Options
Spravato, Ketamine & KAP Programs
Hear From Our Patients
100+ Five Star Reviews. Real Stories. Real Recovery.
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